Provider Demographics
NPI:1407419468
Name:LIM, KAREN
Entity Type:Individual
Prefix:
First Name:KAREN
Middle Name:
Last Name:LIM
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:94-331 PUPUKUPA ST
Mailing Address - Street 2:
Mailing Address - City:WAIPAHU
Mailing Address - State:HI
Mailing Address - Zip Code:96797-2615
Mailing Address - Country:US
Mailing Address - Phone:808-228-0588
Mailing Address - Fax:808-200-1488
Practice Address - Street 1:94-331 PUPUKUPA ST
Practice Address - Street 2:
Practice Address - City:WAIPAHU
Practice Address - State:HI
Practice Address - Zip Code:96797-2615
Practice Address - Country:US
Practice Address - Phone:808-228-0588
Practice Address - Fax:808-200-1488
Is Sole Proprietor?:Yes
Enumeration Date:2019-04-16
Last Update Date:2019-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
376K00000X
HI376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes376K00000XNursing Service Related ProvidersNurse's Aide